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2.
J Craniomaxillofac Surg ; 47(12): 1918-1921, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812305

RESUMO

Krokodil is a cheap and effective home-made substitute for heroin. It is widely used over the territory of the former USSR (Russia, Ukraine, Armenia and others). Krokodil drug-related midface ON often occurs as a complication of maxillary ON. Treatment of Krokodil drug-related ON of the midface is challenging. It is difficult to determine the ON zone preoperatively and intraoperatively, due to the complex anatomy of the midface and the different periods of the disease onset in different areas. The aim of this study is to show variations of the clinical course and treatment options of Krokodil drug-related ON of the midface. In this study, 3 cases of Krokodil drug-related midface ON are reported. The main clinical feature of midface ON is extraoral fistula in the midfacial zone with purulent discharge or extraoral exposure of zygomatic bone. Surgery is the main treatment method for Krokodil drug-related midface osteonecrosis. Surgery includes necrotic bone removal and defect closure. Usually an extraoral approach is used to expose necrotic bone. Intraoral maxillary sinus floor defect is closed with the use of a buccal fat pad to prevent formation of oroantral communication. Drug withdrawal, radical necrectomy, and proper closure of formed defects are the main factors that lead to successful treatment of Krokodil drug-related midface ON patients.


Assuntos
Codeína/análogos & derivados , /química , Necrose/induzido quimicamente , Osteonecrose/induzido quimicamente , Levantamento do Assoalho do Seio Maxilar , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Codeína/efeitos adversos , Codeína/química , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Necrose/cirurgia , Osteonecrose/cirurgia , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (10): 43-49, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626238

RESUMO

OBJECTIVE: To analyze the effectiveness of complex therapy of necrotizing infection using the original method of stimulation of angiogenesis in patients with chronic arterial insufficiency of the lower extremities. MATERIAL AND METHODS: In 53 patients, operations were performed using the proposed technologies for stimulation of angiogenesis. A control group consisting of 56 patients was formed to compare the results of treatment. They had standard vascular therapy for the correction of ischemia. Morphological studies of the muscles of the lower extremities included assessment of capillary bed density and spatial orientation of the capillaries before and after treatment. Computed angiography of the lower extremities followed by calculation of perfusion index was performed to assess changes in the microvasculature. Clinical evaluation of the results was carried out using R. Rutherford scale. RESULTS: Revascularization resulted significant augmentation of capillary bed density and the number of functioning capillaries in muscular tissue. This was accompanied by increased perfusion index and TcPO2 values. The effect of treatment is observed in 12-14 days after surgery and persists for a long time. The best outcomes are found in patients with ischemia grade IIb-III. Incidence of lower limb amputations was more than 2 times lower in the main group compared with the control group. CONCLUSION: Combined stimulation of angiogenesis including mechanical tunneling of the muscles of the affected limb and administration of platelet rich plasma is effective procedure. This method does not require complex equipment and may be used in the treatment of patients with complications of chronic lower limb ischemia and contraindicated direct arterial reconstruction.


Assuntos
Arteriopatias Oclusivas/cirurgia , Capilares/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Necrose/cirurgia , Neovascularização Fisiológica , Arteriopatias Oclusivas/fisiopatologia , Capilares/fisiopatologia , Humanos , /terapia , Isquemia/fisiopatologia , Isquemia/cirurgia , Extremidade Inferior/fisiopatologia , Microvasos/fisiopatologia , Microvasos/cirurgia , Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Necrose/etiologia , Necrose/fisiopatologia , Plasma Rico em Plaquetas/fisiologia , Resultado do Tratamento
4.
J Craniofac Surg ; 30(7): 2268-2270, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503118

RESUMO

In this study, the authors present the challenges of replantation and management of 2 patients who have total scalp, partial forehead and ear avulsion. A 39-year-old male farmer was admitted to the emergency room with the total scalp, forehead, partial right eyebrow and upper eyelid amputation after his hair was catched by an agricultural machine. Anastomoses of 2 arteries and 2 veins in the occipital region were done first. Anastomosis of the right and left superficial temporal arteries and veins were performed end to end by turning the operating table without moving the head, followed by 1 vein anastomoses in the frontal region. Although anastomotic blood flow was observed by Doppler ultrasonography, there were changes suggesting necrosis in the frontal and both temporoparietal regions and later in the occipital region. Necrotic tissues began to be debrided tangentially from the 10th day. During serial debridement, it was observed that the necrotic tissue includes skin and connective tissue. At the end of the post-operative second month, surgical treatment was completed and 12 months after the surgery, the patient lives with the wig because of hair loss, but the patient is cosmetically satisfied. An 18-year-old female gatherer was admitted to the emergency room with the total scalp, both eyebrows, right upper eyelid and partial right ear avulsion, after her hair was catched by an agricultural machine. Totally, anastomoses of 4 arteries and 3 veins were performed. On the 10th post-operative day, necrotic skin findings appeared and serial debridement were performed and it was revealed that aponeurosis was fully intact. The defect areas of skin and connective tissue were repaired with STSG. Intact partial temporal scalp tissue was present. Scalp replantation should always be considered as the first choice, according to the similar tissue principle of tissue repair in plastic surgery if there is no contraindication. Additionally, performing multiple arterial and vein anastomoses, evaluating the patient position in the post-operative period for anastomosis and hemodynamic follow-up, avoiding aggressive debridement and early reconstruction may give the patient the chance of skin grafting which is the basis of the reconstructive ladder.


Assuntos
Orelha/cirurgia , Testa/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Couro Cabeludo/cirurgia , Adolescente , Adulto , Alopecia , Anastomose Cirúrgica , Desbridamento , Orelha/irrigação sanguínea , Feminino , Testa/irrigação sanguínea , Cabelo , Humanos , Masculino , Microcirurgia , Necrose/cirurgia , Couro Cabeludo/irrigação sanguínea
5.
J Craniofac Surg ; 30(5): e434-e436, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299805

RESUMO

Denosumab is an antiresorptive agent that is found as a humanized antibody, which inhibits the most critical pro-osteoclastogenic factor secreted by the cancer cells and shown to be required for osteoclast formation, function, and development. A severe side effect of denosumab is the osteonecrosis of the jaw (DRONJ). There are only a few studies on DRONJ treatment in the literature. The aim of this case report is to present the successful conservative management of DRONJ observed after tooth extraction at the posterior maxilla following the discontinuation of medication. To our knowledge, this is the first DRONJ case treated with using the ultrasonic piezoelectric bone surgery combined with leukocyte and platelet-rich fibrin (L-PRF) and pedicled buccal fat pad flap (PBFP). Use of ultrasonic bone surgery in combination with L-PRF and PBFP is an alternative treatment method that can be effective in exposed bone coverage and soft tissue healing at the posterior maxillary region in DRONJ patients.


Assuntos
Denosumab/efeitos adversos , Leucócitos , Osteoporose/cirurgia , Fibrina Rica em Plaquetas , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Ultrassônicos , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/induzido quimicamente , Necrose/cirurgia , Osteoporose/induzido quimicamente , Osteoporose/patologia , Extração Dentária , Cicatrização
6.
Khirurgiia (Mosk) ; (7): 63-70, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355817

RESUMO

AIM: Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. MATERIAL AND METHODS: It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. RESULTS: Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Biguanidas/administração & dosagem , Pé Diabético/cirurgia , Necrose/cirurgia , Procedimentos Cirúrgicos Ultrassônicos , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/tratamento farmacológico , Pé Diabético/patologia , Humanos , Pessoa de Meia-Idade , Necrose/tratamento farmacológico , Necrose/patologia , Soluções/administração & dosagem
7.
BMJ Case Rep ; 12(6)2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31217212

RESUMO

Uterine torsion is an uncommon entity that is defined as a rotation of greater than 45° around the longitudinal axis of the uterus. Although cases of uterine torsion among pregnant patients have been mentioned in the literature, torsion of a non-gravid uterus is a rare occurrence. A 73-year-old nulliparous woman with a known fibroid uterus underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with frozen section of a 17-18 cm pelvic mass seen on CT imaging. The source of the pelvic mass was unclear on imaging, and benign and malignant possibilities were discussed. During the procedure, necrosis of the uterine fundus and bilateral adnexa were seen due to the fundus being torsed with the uterine fibroid being the pivot point. Uterine torsion, though rare, can be the cause of acute pelvic pain in a postmenopausal woman.


Assuntos
Dor Abdominal/diagnóstico por imagem , Doenças dos Anexos/diagnóstico por imagem , Leiomioma/patologia , Necrose/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Ultrassonografia , Doenças Uterinas/diagnóstico por imagem , Dor Abdominal/cirurgia , Doenças dos Anexos/patologia , Doenças dos Anexos/cirurgia , Idoso , Feminino , Secções Congeladas , Humanos , Histerectomia , Necrose/patologia , Necrose/cirurgia , Pós-Menopausa , Salpingo-Ooforectomia , Anormalidade Torcional/patologia , Anormalidade Torcional/cirurgia , Resultado do Tratamento , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia
8.
Med Sante Trop ; 29(1): 84-87, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31031256

RESUMO

Posttraumatic diaphragmatic hernias have long been known, but the variety of their clinical expression can lead to diagnostic delay and difficulties in treatment. An intrathoracic hernia of hollow abdominal viscera with subsequent necrosis and perforation is an uncommon late complication with poor prognosis. Surgical treatment is mandatory. Laparotomy is an excellent approach, making it possible to achieve therapeutic objectives for the abdomen and thorax with a short operative time and minimal complications in these patients whose hemodynamic status is often precarious. We report 2 cases of posttraumatic left diaphragmatic hernias with intrathoracic necrosis of the digestive tract, treated by laparotomy.


Assuntos
Colo/cirurgia , Hérnia Diafragmática Traumática/cirurgia , Laparotomia , Necrose/cirurgia , Adulto , Colo/patologia , Colostomia , Hérnia Diafragmática Traumática/complicações , Humanos , Masculino , Necrose/etiologia
9.
Wounds ; 31(6): 137-144, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30990780

RESUMO

INTRODUCTION: A new pneumatic dermatome with a circular excision blade was designed to improve a number of disadvantages of regular dermatomes. OBJECTIVE: This study analyzes the safety and efficacy of a new dermatome (test device) for the tangential excision of necrosis and harvesting of split-thickness skin grafts (STSGs). MATERIALS AND METHODS: Three porcine proof-of-concept studies were conducted to compare the test dermatome with conventional dermatomes (control devices) for both excision of necrosis (one study) and the harvesting of a STSG (2 studies). For the harvesting studies, donor sites and grafts were analyzed for viability, healing rate, and scar outcomes. Biomechanical tests also were performed on the donor sites. For the necrotectomy study, healing of the excised area and thickness of the excised tissues were studied. RESULTS: The test device was similar to the control devices in viability of collected tissues, speed of healing, and donor site biomechanics. In 1 graft harvesting study, as well as in the excision study, uniformity of the thickness of the harvested tissues was better for the test device than for the control devices. The test device performed better than the controls on maneuverability, control of the consistency of the relationship between depth setting and actual graft thickness, device assembly, overall ease of use, depth of the debridement as intended, consistency of the debridement thickness, device accuracy, and size. CONCLUSIONS: The studies showed the test device, when compared with the control devices, was equal on safety. On efficacy, consistency of the excised tissues was superior for the test device, which may result in better grafts and outcomes. Several aspects related to the ease of use, particularly maneuverability, were superior as well.


Assuntos
Transplante de Pele/métodos , Coleta de Tecidos e Órgãos/métodos , Cicatrização/fisiologia , Ferimentos e Lesões/cirurgia , Animais , Autoenxertos , Desbridamento/métodos , Modelos Animais de Doenças , Humanos , Necrose/cirurgia , Sensibilidade e Especificidade , Suínos
11.
Am J Dermatopathol ; 41(9): 661-666, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30839343

RESUMO

In this report, we describe a case of a patient with a clinical history of systemic sarcoidosis and psoriasis who developed biopsy-confirmed perforating and necrotizing cutaneous granulomas after 12 months of treatment with adalimumab, a tumor necrosis factor-alpha-inhibiting, anti-inflammatory, biologic medication, prescribed for the patient's psoriasis. Although rare reports of a "sarcoidosis-like" reaction associated with select tumor necrosis factor-alpha agents exist, to the best of our knowledge, perforating and necrotizing cutaneous granulomas after treatment with adalimumab has not been previously reported. Given the patient's history of systemic sarcoidosis, the differential diagnosis includes reactivation of latent sarcoidosis with adalimumab as a trigger.


Assuntos
Adalimumab/efeitos adversos , Granuloma/induzido quimicamente , Granuloma/terapia , Psoríase/tratamento farmacológico , Sarcoidose/tratamento farmacológico , Cicatrização/fisiologia , Adalimumab/uso terapêutico , Idoso , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Biópsia por Agulha , Terapia Combinada , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Seguimentos , Granuloma/patologia , Humanos , Imuno-Histoquímica , Perna (Membro) , Masculino , Necrose/induzido quimicamente , Necrose/cirurgia , Prednisona/uso terapêutico , Psoríase/complicações , Psoríase/patologia , Recidiva , Sarcoidose/complicações , Sarcoidose/patologia , Índice de Gravidade de Doença , Transplante de Pele/métodos , Úlcera Cutânea/induzido quimicamente , Úlcera Cutânea/patologia , Úlcera Cutânea/cirurgia , Fatores de Tempo
13.
Ann Chir Plast Esthet ; 64(2): 208-214, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30745022

RESUMO

INTRODUCTION: Management of the combined loss of Achilles tendon and skin is difficult. However, these are not exceptional situations after Achilles tendon surgery. Data from the literature are extensive and there is currently no consensus on the technique of tendon reconstruction. CASE REPORTS: We report four cases of purulent necrosis of the Achilles tendon complicating longitudinal incision or suturing of a tendon rupture. After debridement of necrotic tissue, the defect was covered either by a fasciocutaneous perforating flap or a thin skin graft without reconstruction of the underlying tendon. DISCUSSION AND CONCLUSION: The functional results are very satisfactory with good joint mobilities and a resumption of walking without lameness for all patients. Fibrosis can reconstitute a true neo-tendon confirmed on MRI. The advantages are many compared to other methods: a single operating time is necessary, the postoperative management is simple and it avoids certain technical difficulties related to tendon reconstruction. A larger series would be needed to support these results.


Assuntos
Tendão do Calcâneo/lesões , Retalhos Cirúrgicos/transplante , Tendão do Calcâneo/patologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/cirurgia , Fotografação , Procedimentos Cirúrgicos Reconstrutivos , Ruptura/cirurgia , Supuração
14.
J Laparoendosc Adv Surg Tech A ; 29(7): 891-899, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30762470

RESUMO

Background: The step-up approach, using either flexible endoscopy or a minimal invasive retroperitoneal access, has reduced mortality and morbidity in patients with acute pancreatitis. The use of fully covered self-expanding metal stents (FCSEMS) or lumen apposing metal stents (LAMS) facilitates endoscopic necrosectomy and drainage of walled-off necrosis (WON). The aim of our analysis was to investigate the 30/90/365-day mortality and morbidity rates of the subtypes of the revised Atlanta classification for acute pancreatitis. Materials and Methods: We conducted a retrospective analysis of all patients (n = 302) treated with acute pancreatitis in our institution from January 2014 to July 2017. Mortality, morbidity, management of fluid collections, interventions, complications, and new onset of diabetes were recorded. Results: In 30.8% (n = 93/302) of patients, pancreatic fluid collection developed. Out of these, 58.1% (54/93) required intervention, consisting of endoscopic treatment in 63% (34/54) or multidisciplinary approach in 37% (20/54). Overall, 90-day mortality rate according to Kaplan-Meier Estimator was 3.7%. Overall, 1-year mortality rate was 6.2%. One-year mortality for uncomplicated acute pancreatic fluid collection, pseudocyst, and WON were 5.4%, 2.6%, and 13.5%, respectively. Hemorrhage in case of metal stent treatment (FCSEMS/LAMS) occurred in 14.3%. If LAMS was combined with double pigtail stent-in-stent, bleeding was seen in 5.3%. No transperitoneal necrosectomy was needed. Conclusions: Treating acute pancreatitis with a step-up approach, including stent-in-stent procedures, leads to low mortality rates and few stent-associated bleeding complications and minimizes necessity for open transperitoneal surgical necrosectomy.


Assuntos
Drenagem/métodos , Hemorragia/etiologia , Pancreatite Necrosante Aguda/cirurgia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Drenagem/efeitos adversos , Drenagem/instrumentação , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Necrose/cirurgia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/mortalidade , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/efeitos adversos
15.
G Chir ; 40(1): 54-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30771800

RESUMO

Discovery of an apparent scrotal mass is a non common entity in neonates. Testicular torsion is rare in newborn infants and is an urologic emergency that requires emergency surgical management. We present a rare case of testicular torsion in a neonate.


Assuntos
Orquiectomia , Orquidopexia , Torção do Cordão Espermático/cirurgia , Diagnóstico Precoce , Humanos , Recém-Nascido , Masculino , Necrose/etiologia , Necrose/cirurgia , Cordão Espermático/patologia , Torção do Cordão Espermático/diagnóstico por imagem , Testículo/patologia , Ultrassonografia
16.
J Surg Res ; 238: 119-126, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30769248

RESUMO

BACKGROUND: The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score may distinguish necrotizing soft tissue infection (NSTI) from non-NSTI. The association of higher preoperative LRINEC scores with escalations of intraoperative anesthesia care in NSTI is unknown and may be useful in communicating illness severity during patient handoffs. MATERIALS AND METHODS: We conducted a retrospective cohort study of first operative debridement for suspected NSTI in a single referral center from 2013 to 2016. We assessed the association between LRINEC score and vasopressors, blood products, crystalloid, invasive monitoring, and minutes of operative and anesthesia care. RESULTS: We captured 332 patients undergoing their first operative debridement for suspected NSTI. For every 1-point higher LRINEC score, there was a higher risk of norepinephrine and vasopressin use (relative risk [RR] = 18%, 95% confidence interval [CI] [10%, 26%] and [10%, 27%], respectively), packed red blood cell use (RR = 28% [95% CI 13%, 45%]), and additional crystalloid (17.57 mL/h [95% CI 0.37, 34.76]). Each additional LRINEC point was associated with longer anesthesia (3.42 min, 95% CI 0.94, 5.91) and operative times (2.35 min, 95% CI 0.29, 4.40) and a higher risk of receiving invasive arterial monitoring (RR 1.11, 95% CI 1.05, 1.18). The negative predictive value for an LRINEC score < 6 was > 90% for use of vasopressors and packed red blood cells. CONCLUSIONS: Preoperative LRINEC scores were associated with escalations in intraoperative care in patients with NSTI. A low score may predict patients unlikely to require vasopressors or blood and may be useful in standardized handoff tools for patients with NSTI.


Assuntos
Anestesia/métodos , Cuidados Intraoperatórios/métodos , Índice de Gravidade de Doença , Infecções dos Tecidos Moles/diagnóstico , Adulto , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Desbridamento/efeitos adversos , Diagnóstico Diferencial , Fasciite Necrosante/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/cirurgia , Duração da Cirurgia , Período Pré-Operatório , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Infecções dos Tecidos Moles/cirurgia
18.
Cir Cir ; 87(1): 45-52, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30600808

RESUMO

Introduction: The purpose of this prospective cohort study was to evaluate whether serum procalcitonin (PCT) levels predict the need for surgery and the presence of ischemia and/or necrosis (I/N) in small bowel obstruction. Method: Of 54 patients included, conservative management was performed in 31 (non-surgical group) and an exploratory laparotomy in 23 (surgical group). The reference value of the PCT was between 0.10 and 0.50 ng/mL. Results: PCT levels were higher in the surgical group (7.05 ± 7.03 ng/mL) than in the non-surgical (0.37 ± 0.63 ng/mL), and in patients with I/N (10.06 ± 7.07 ng/mL) than without I/N (1.52 ± 1.45 ng/mL). In the ROC curve, the area under the curve was 0.91 for the need for surgery and 0.93 for I/N. PCT ≥ 0.80 ng/mL had the best sensitivity and specificity for surgery and ≥ 1.95 ng/mL for I/N. PCT was also an independent predictor for these events. Conclusions: The levels of PCT can recognize the need for surgery and the presence of I/N in small bowel obstruction. Additional studies are needed to affirm or invalidate our findings.


Assuntos
Obstrução Intestinal/sangue , Intestino Delgado/irrigação sanguínea , Intestino Delgado/patologia , Isquemia/sangue , Pró-Calcitonina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Necrose/sangue , Necrose/cirurgia , Valor Preditivo dos Testes
19.
Eur J Trauma Emerg Surg ; 45(4): 705-711, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29947847

RESUMO

INTRODUCTION: The overuse of temporary abdominal closure and second look (SL) laparotomy in emergency general surgery (EGS) cases has been questioned in the recent literature. In an effort to hopefully decrease the number of open abdomen (OA) patients, we hypothesize that reviewing our cases, many of these SL patients could be managed with single-stage operative therapy and thus decrease the number of OA patients. METHODS: This is a retrospective review of prospectively collected data from Jun 2013-Jun 2014, evaluating EGS patients managed with an OA who required bowel resection in either index or SL laparotomy. Demographics, clinical variables, complications and mortality were collected. Fisher's exact t test was used for statistical analysis. RESULTS: During this time frame, 96 patients were managed with OA and 59 patients required a bowel resection. 55 (57%) of those required one bowel resection at the index operation with 4 (4.2%) only requiring one bowel resection at the second operation. In the patients requiring bowel resections, 18 (30%) required a resection at SL. At SL laparotomy, resection was required for questionably viable bowel at the index operation 60% (11), whereas 39% (7) had normal appearing bowel. Indications for resection at SL laparotomy included evolution of existing ischemia, new onset ischemia, staple line revision, and "other". 23 patients (39%) were hemodynamically unstable, contributing to the need for temporary abdominal closure. In the multivariate analysis, preoperative shock was the only predictor of need for further resection. Complications and mortality were similar in both groups. CONCLUSION: Almost one-fifth of the patients undergoing SL laparotomy for open abdomen required bowel resections, with 6.8% of those having normal appearing bowel at index operation, therefore in select EGS patients, SL laparotomy is a reasonable strategy.


Assuntos
Enteropatias/cirurgia , Laparotomia/estatística & dados numéricos , Abdome/cirurgia , Idoso , Feminino , Humanos , Intestinos/irrigação sanguínea , Intestinos/patologia , Isquemia/cirurgia , Masculino , Maryland , Pessoa de Meia-Idade , Necrose/cirurgia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos
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